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Biomedical subjects

S J Youngner

Publications and source records attributed to S J Youngner.

At least 55 records · Page 3Linked to original sources
PubMed1990

Orchestrating a dignified death in the intensive-care unit.

Approximately 2 million people die in the United States each year, 80% of them in acute- or chronic-care institutions. Physicians now have at their disposal interventions that can postpone death in almost every instance. In these circumstances the critical-care physician cannot avoid the responsibility of orchestrating death by balancing factors such as the patient's autonomy and best interests, medical uncertainty and futility, and notions of "passive" (permissible) and "active" (forbidden) euthanasia. Pressures to make decisions unilaterally and without patient input threaten to undermine important physician/patient/family dialogue. On the other hand, the fact that medical resources are becoming increasingly expensive and scarce will inevitably lead to rationing. The critical-care physician will be caught in the middle--orchestrating clinical care to balance the interests of individual patients and families against those of the larger community.

Aged↗
PubMed1989

'Brain death' and organ retrieval. A cross-sectional survey of knowledge and concepts among health professionals.

A sample of 195 physicians and nurses likely to be involved in organ procurement for transplantation was interviewed about knowledge, personal concepts, and attitudes concerning "brain death" and organ donation. Only 68 respondents (35%) correctly identified the legal and medical criteria for determining death. Personal concepts of death varied widely. Most respondents (58%) did not use a coherent concept of death consistently; others (19%) had a concept of death that was logically consistent with changing the whole-brain standard to classify anencephalics and patients in a persistent vegetative state as dead. The findings demonstrate confusion about correct criteria for determining death and differences in concepts of death that might prove troublesome to the transplantation enterprise. We conclude that health professionals should do more to resolve the clinical and conceptual issues in the definition and determination of death before policies concerning organ retrieval are changed.

Attitude of Health Personnel↗
PubMed1987

Do-not-resuscitate orders: no longer secret, but still a problem.

Over the past decade, public discussion has focused on the ethics of issuing Do-Not-Resuscitate Orders, and the failure of many hospitals to acknowledge their actions openly. Recent efforts on the part of some hospitals to establish formal DNR guidelines that are prudent, fair, and humane, are a helpful beginning, though they cannot account for all the vagaries of illness and human communication. But concerns about DNR should not divert us from looking closely and rigorously at other, more common treatment/nontreatment decisions in the critical care setting.

Disclosure↗
PubMed1986

Patient autonomy, informed consent, and the reality of critical care.

The realities of serious illness and critical care environments often complicate our efforts to evaluate treatment refusal according to the doctrine of informed consent. However, health professionals must strive to use informed consent as the ultimate standard for both treatment and nontreatment decisions, by making continual efforts to communicate with patients, share information, and enhance their sense of autonomy and control.

Aged↗
PubMed1985

'Do not resuscitate' orders. Incidence and implications in a medical-intensive care unit.

"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.

Aged↗
PubMed1984

ICU visiting policies.

Head nurses from 78 ICUs in 37 northeast Ohio hospitals were interviewed about visiting policies. There was tremendous variation with regard to frequency and length of visits; 25% of these ICUs allowed only 2 visits/day, and 42% restricted visits to under 20 min. Most units rarely or never allowed children under 12 yr old to visit. Traditional rationales for restricted visiting are not supported by studies in the literature, nor are they consistent with current concepts of patients' rights. In an era where high technology and medicine by-the-numbers threaten to dehumanize patients, open visiting is an important part of the humanization process.

Adult↗
PubMed1983

A national survey of hospital ethics committees.

A telephone survey of 602 randomly selected hospitals was conducted to identify existing ethics committees, i.e., those with the potential to become involved in the decision-making process in specific cases. Using the number of acute care beds as the criterion, hospitals were divided into 2 groups: (1) over 200 beds; n = 400; (2) 200 or fewer beds; n = 202. Chairpersons of identified committees completed detailed questionnaires. Seventeen committees were found--approximately 1% of all U.S. hospitals. A typical committee included physicians, clergymen, and other professionals. Almost all committees were advisory, not decision-making bodies, and considered very effective by their chairpersons. Ethics committees have not, however, solved current medical ethical problems; nor have they allayed the concerns of patients' rights advocates about patient representation and control. Further study is warranted.

Ethical Review↗
PubMed1983

Human death and high technology: the failure of the whole-brain formulations.

Modern technology has raised questions about the definition of death, and various factors that influence public policy about declaring people dead. The widely accepted "whole-brain" definition of death is inadequate and should be replaced by a definition of "irreversible loss of consciousness and cognition." Any definition that identifies the innate ability of the organism to "integrate" itself or function "as a whole" should be rejected. The proponents of such definitions fail to provide a standard for the selection of essential sub-systems. The innate integration of vegetative functions cannot be used as the necessary and sufficient condition for life. A person without innate integration can still be alive; a dead person retaining just this function can survive as a living, mindless organism. Only cognitive functions have a spontaneity that is, in principle, irreplaceable.

Brain↗